Care Quality Services Coventry

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People were safe. Records of people’s referrals and healthcare appointments were made at times people needed. Rotas demonstrated staff supported the same people and people told us, staff stayed for the required times. There were sufficient staff with the necessary skills to support people, however some people told us some staff new to them, required more training. In some cases, people and relatives raised concerns but found communication sometimes limited as messages had not always been followed up. In these cases, lessons were not always learnt. People felt safe supported by staff in their own homes with staff having information about the person they supported. Processes to manage risks were assessed but some risks and daily records required more specific information to ensure staff provided consistent care. Managers understood local processes and procedures for ensuring continuity of care as people moved between services. People received their medicines at the required times.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and relatives told us they were pleased with the service, however some felt communication was not always efficient. Some people said messages were given to office staff or left on an answer machine, but they were not always responded too. Some relatives told us they had given feedback about some staff not always knowing how to support their family members condition. In one case, the occasional issue happened a few times which did not give them complete confidence the provider had always learnt from feedback.

We found the manager, regional manager and director were open and honest in what needed improvement before this assessment. The regional manager told us they had recently addressed issues around the culture at the service which was more positive in recent months. Staff told us the service and culture had improved and staff felt they worked better as a team. The manager understood more checks were needed because we found some checks did not always identify where improvements were needed. Staff told us they felt supported and were confident to raise any concerns. Staff knew who to report concerns to. For example, one staff member said, “If there was something wrong with medicines, I would call the office and take advice on next steps.”

We reviewed the quality assurance systems which supported those improvements alongside improved oversight from internal quality assurance teams. Those improvements helped support a more positive culture. People’s feedback was regularly sought so people’s views and feedback was seen as an important part of improving the service. However, we found 2 examples that had been raised but had not been confidently resolved. The regional manager said they would look to strengthen some checks to ensure lessons were learnt to improve practice and standards.

People and their relatives told us they felt their service worked well with other health professionals such as the doctor and district nurses. People told us they received continuity in the staff who provided their care. One person said, “I have the same care staff and I'm glad about that, it's reassuring. There are two who are the most regular ones, and they are fantastic.”

Staff, a manager and field coordinators said they had a positive professional relationship with external professionals to ensure people’s needs were met well. Staff gave us examples when they could request GP support when needed, via office staff. A care co-ordinator explained that when a person was admitted to hospital, they maintained contact with the hospital to ensure the care package was reinstated immediately on their discharge. They told us, “We contact the hospital and find out which ward they are admitted to and we contact them and ask them to let us know when they are going to be discharged.”

Feedback received was positive from external professionals who worked alongside staff to support people who needed additional support and treatment.

There were safe systems to ensure important was shared with health and social care professionals. The providers electronic care planning system produced a short document describing people’s needs and requirements. This information was available to the person and relative via an electronic ‘app’ to ensure it remained updated which helped safe transitions between services.

People were positive about the way their safety was considered and people felt safe receiving care in their own home. One person told us,” I do feel safe, and I think it's mainly because we have got to know each other.” A relative said, “We learnt within the first week that we could rely on them and trust them, they’re still doing that now.’

Staff told us they were trained in how to recognise and report abuse. Staff knew how to escalate concerns and they were confident any concerns passed to the manager would be actioned. One staff member said, “If I saw anything, I would make the client safe, report to the office and if they did nothing, next is social worker, CQC and escalate it step by step.”

Safe systems included a review of reported safeguarding incidents, observed practice and supervisions of staff to check they supported people safely. Regular meetings and training sessions discussed any themed learning from incidents or accidents and people’s feedback was sought to ensure they continued to feel safe.

Overall, the majority of people were pleased with the support they received. People and relatives said risks were managed related to medicines, moving and handling and people felt safe when staff supported them, at times they required. However, some people were less satisfied at times when staff not always assigned to their care call, supported them. Relatives felt some staff could benefit from additional training to refresh their knowledge and skills.

Staff knew how to manage risks. Staff told us they relied on the provider’s electronic application to inform them of managing people’s risks and any risks within the home environment. The provider used consistent staff teams to support people which meant staff knew people well. Observed practices helped make sure staff managed known risks. One staff member said, “If we can advise them (staff) of a safer way of doing it, then all the better." In some cases, other health professionals helped support people to minimise risks.

The provider had processes to manage and monitor risks across the service. We found some processes required better management and oversight. Daily records we saw required more detail for example, when thickener was added to fluids, fluid intake and urine output for people with a catheter were not consistently recorded. In some cases, guidance for staff in a person’s home to offer thickened fluids was unclear and contradictory. The regional manager recognised improvements were required to improve processes to manage risks.

People and relatives felt staff respected their home environment. A positive comment was, “We have two small dogs and most of the care staff are fine with the dogs.” A relative said they had CCTV at the property and said care staff always left the premises safe and secured.

A field supervisor responsible for carrying out assessments of people’s needs explained the importance of ensuring risks in people’s homes were identified and actions taken to mitigate those risks. Care staff said they considered fire risks, such as clothing on or near a source of heat. They said they would remind people and remove clothing if it caused a safety issue.

Any environmental risks within people’s homes were identified during the assessment process. Information was included in people’s support plans about any actions staff should take to keep themselves and people safe. Where equipment was required to support people, there was guidance informing staff how they should check the equipment to ensure it was safe to use.

Majority of people's experience was positive. Comments included, “I do feel they are safe as staff understood [Relative] very well and was on the ball with things.” People told us they got on well with staff and they received the same staff at the times they wanted. People and relatives said where staff changes took place, some staff were not as exact as those who usually supported them, but people understood this. For people who had two staff to support them, this was followed.

A care co-ordinator told us there were enough care staff to allocate all the calls people required. They explained how care calls were allocated to ensure people received care from a consistent staff team. They explained, “Consistency is predominately for the service user because most of them don’t like change and when they get to know the carers they develop a good relationship, and the carers know their routine on a daily basis.” Care staff told us they had travel time between calls and were not rushed. They had time to support people for the duration of the calls.

The provider used an electronic system to allocate people’s care calls. Calls were grouped geographically to ensure consistency in staff delivering individual care packages and staff did not have to travel excessive distances between calls. The electronic system was monitored and if a member of care staff was late to a call, office staff would contact them to enquire about the delay. Office staff monitored the care calls ‘live’ on the system so could intervene if calls were running later than planned. There were effective processes to ensure staff were recruited safely.

People had no concerns with overall cleanliness and infection prevention and control. One relative told us, “My [Relative] says that they (staff) wear gloves and they do throw them in the rubbish when they’ve finished, and they seem clean and professional.” One person told us care staff always tidied up after themselves and left their premises as they would expect.

Staff spoken with said they had enough personal protective equipment (PPE) and demonstrated an understanding of what they would do in the event of an outbreak. One staff member said, “If there was an outbreak I would ensure to wear all PPE, gloves apron and masks, washing and cleaning the house regularly.” A staff member told us how they disposed of the used PPE safely.

People's risk assessments included information about managing the risk of infection. This included guidance about the use of PPE and the safe disposal of any waste. Observed practice was completed to ensure staff had and used appropriate PPE and when required, the provider reminded staff of any government guidance regarding a pandemic.

People received their medicines from trained staff and if people could administer their own medicines, this was encouraged. One relative told us, “Staff seem to be very good on the times of the calls and this is very important because [Relative] has about 28 tablets, so the timing is very important.”

Staff members told us that people’s prescribed medicines were included on their electronic application, under a separate electronic medicine record. Staff were clear what was prescribed and what was a medicine to be given on an as and when basis. Staff said they had information to tell them what dose people required for each medicine. One staff member said, “We make sure we give the right medicines, to the right person, at the right time by the right route.” The manager said they completed sample checks of electronic medicines records to check medicines were administered safely.

Processes included staff training, competency assessments on staff, audit checks and reviews. However, we found 4 PRN protocols not in place, information for 1 person’s thickener had inconsistent guidance and electronic medicines records did not record if thickener was required or not. Regular checks had not identified the issues we found during our assessment.